Skip to main content
Log in

The Management of Acne Vulgaris in Pregnancy

  • Therapy in Practice
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Acne vulgaris is a common condition in adolescence and also for many women of childbearing age. The management of acne in pregnancy is complicated by the lack of clinical studies and pharmacokinetic data in this patient population and safety concerns regarding retinoid use in pregnancy. Of primary concern to both patients and clinicians is the safety profile of medications used during pregnancy. This review seeks to clarify what management options are available to treat acne during pregnancy and what data are available to guide decision making. Topical treatments are considered the safest option during pregnancy. They have the best safety profile and minimize the levels of systemic absorption, and therefore the least risk of fetal exposure. If these are applied properly with a strong emphasis on adherence, excellent results can be achieved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References:

  1. Smithard A, Glazebrook C, Williams HC. Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study. Br J Dermatol. 2001;145:274–9.

    Article  PubMed  CAS  Google Scholar 

  2. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013;168:474–85.

    Article  PubMed  CAS  Google Scholar 

  3. Williams C, Layton AM. Persistent acne in women: implications for the patient and for therapy. Am J Clin Dermatol. 2006;7(5):281–90.

    Article  PubMed  Google Scholar 

  4. Shafer T, Nienhaus A, Vieluf D, et al. Epidemiology of acne in the general population: the risk of smoking. Br J Dermatol. 2001;145:100–4.

    Article  Google Scholar 

  5. Burton JL, Cunliffe WJ, Stafford I, et al. The prevalence of acne vulgaris in adolescence. Br J Dermatol. 1971;85:119–26.

    Article  PubMed  CAS  Google Scholar 

  6. US Food and Drug Administration. List of pregnancy exposure registries [online]. http://www.fda.gov/scienceresearch/specialtopics/womenshealthresearch/ucm134848.htm (Accessed 12 Dec 2012).

  7. FDA Consumer Health Information. Pregnant women to benefit from better information [online]. http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM143746.pdf (Accessed 12 Dec 2012).

  8. Strauss JS, Krowchuk DP, Leyden JJ, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007;56:651–63.

    Article  PubMed  Google Scholar 

  9. Nast A, Dréno B, Bettoli V, et al. European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermatol Venereol. 2012;26:1–29.

    Article  PubMed  Google Scholar 

  10. Elling SV, Powell FC. Physiological changes in the skin during pregnancy. Clin Dermatol. 1997;15:35–43.

    Article  PubMed  CAS  Google Scholar 

  11. Burton JL, Cunliffe WJ, Millar DG, Shuster S. Effect of pregnancy on sebum excretion. BMJ. 1970;2:769–71.

    Article  PubMed  CAS  Google Scholar 

  12. Muzaffar F, Hussain I, Haroon TS. Physiologic skin changes during pregnancy: a study of 140 cases. Int J Dermatol. 1998;37:429–31.

    Article  PubMed  CAS  Google Scholar 

  13. Dawes M, Chowienczyk PJ. Drugs in pregnancy: pharmacokinetics in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2001;15:819–26.

    Article  PubMed  CAS  Google Scholar 

  14. Loebstein R, Lalkin A, Koren G. Pharmacokinetic changes during pregnancy and their clinical relevance. Clin Pharmacokinet. 1997;33:328–43.

    Article  PubMed  CAS  Google Scholar 

  15. Boothby LA, Doering PL. FDA labeling system for drugs in pregnancy. Ann Pharmacother. 2001;35:1485–9.

    Article  PubMed  CAS  Google Scholar 

  16. Public Affairs Committee of the Teratology Society. Teratology Public Affairs Committee position paper: pregnancy labeling for prescription drugs: ten years later. Birth Defects Res Part A Clin Mol Teratol. 2007;79:627–30.

    Article  Google Scholar 

  17. Addis A, Sharabi S, Bonati M. Risk classification systems for drug use during pregnancy: are they a reliable source of information? Drug Saf. 2000;23(3):245–53.

    Article  PubMed  CAS  Google Scholar 

  18. US Food and Drug administration. Pregnancy and lactation labeling [online]. http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Labeling/ucm093307.htm (Accessed 12 Dec 2012).

  19. MIMS USA drug information system [online]: http://www.mims.com/USA/Viewer/Html/PregDef.htm (Accessed 12 Dec 2012).

  20. Tanghetti E. The evolution of benzoyl peroxide therapy. Cutis. 2008;82(5 Suppl.):5–11.

    PubMed  Google Scholar 

  21. Yeung D, Nacht S, Bucks D, Maibach HI. Benzoyl peroxide: percutaneous penetration and metabolic disposition. II. Effect of concentration. J Am Acad Dermatol. 1983;9:920–4.

    Article  PubMed  CAS  Google Scholar 

  22. Nacht S, Yeung D, Beasley JN, et al. Benzoyl peroxide: percutaneous penetration and metabolic disposition. J Am Acad Dermatol. 1981;4(1):31–7.

    Article  PubMed  CAS  Google Scholar 

  23. Camera G, Pregliasco P. Ear malformation in baby born to mother using tretinoin cream. Lancet. 1992;339:687.

    Article  PubMed  CAS  Google Scholar 

  24. Lipson AH, Collins C, Webster W. Multiple congenital defects associated with maternal use of topical tretinoin. Lancet. 1993;341:1352–3.

    Article  PubMed  CAS  Google Scholar 

  25. Selcen D, Seidman S, Nigro MA. Otocerebral anomalies associated with topical tretinoin use. Brain Dev. 2000;22:218–20.

    Article  PubMed  CAS  Google Scholar 

  26. Navarre-Belhassen C, Blanchet P, Hillaire-Buys D, et al. Multiple congenital malformations associated with topical tretinoin. Ann Pharmacother. 1998;32:505–6.

    Article  PubMed  CAS  Google Scholar 

  27. Autret E, Berjot M, Jonville-Béra A-P, et al. Anophthalmia and agenesis of optic chiasma associated with adapalene gel in early pregnancy. Lancet. 1997;350:339.

    Article  PubMed  CAS  Google Scholar 

  28. Organisation of Teratology Information specialists. Tretinoin (Retin-A®) and pregnancy [online]. http://www.otispregnancy.org/files/tretinoin.pdf (Accessed 12 Dec 2012).

  29. Jick SS, Terris BZ, Jick H. First trimester topical tretinoin and congenital disorders. Lancet. 1993;341:1181–2.

    Article  PubMed  CAS  Google Scholar 

  30. Panchaud P, Csajka C, Merlob P, et al. Pregnancy outcome following exposure to topical retinoids: a multicentre prospective study. J Clin Pharmacol. 2012;52:1844–51.

    Article  PubMed  CAS  Google Scholar 

  31. Van Hoogdalem EJ. Transdermal absorption of topical anti-acne agents in man; review of clinical pharmacokinetic data. J Eur Acad Dermatol Venereol. 1998;11 Suppl. 1:S13–9.

    Article  PubMed  Google Scholar 

  32. Akhavan A, Bershad S. Topical acne drugs: review of clinical properties, systemic exposure and safety. Am J Clin Dermatol. 2003;4:473–92.

    Article  PubMed  Google Scholar 

  33. Joint Formulary Committee. British National Formulary. 64th ed. London: BMJ Group and Pharmaceutical Press; 2012.

    Google Scholar 

  34. Frampton JE, Wagstaff AJ. Azelaic acid 15% gel in treatment of papulopustular rosacea. Am J Clin Dermatol. 2004;5:57–64.

    Article  PubMed  Google Scholar 

  35. Täuber U, Weiss C, Matthes H. Percutaneous absorption of azelaic acid in humans. Exp Dermatol. 1992;1:176–9.

    Article  PubMed  Google Scholar 

  36. Koren G, Pastuszak A, Ito S. Drugs in pregnancy. N Engl J Med. 1998;338:1128–37.

    Article  PubMed  CAS  Google Scholar 

  37. Feldmann RJ, Maibach HI. Absorption of organic compounds through the skin in man. J Invest Dermatol. 1970;54:399–404.

    Article  PubMed  CAS  Google Scholar 

  38. Dreno B, Bettoli V, Ochsendorf F, et al. European recommendations on the use of oral antibiotics for acne. Eur J Dermatol. 2004;14:391–9.

    PubMed  Google Scholar 

  39. Harkaway KS, McGinley KJ, Foglia AN, et al. Antibiotic resistance patterns in coagulase-negative staphylococci after treatment with topical erythromycin, benzoyl peroxide, and combination therapy. Br J Dermatol. 1992;126:586–90.

    Article  PubMed  CAS  Google Scholar 

  40. Hernandez S, Werler MM, Walker AM, et al. Folic acid antagonists during pregnancy and the risk of birth defects. N Engl J Med. 2000;343:1608–14.

    Article  Google Scholar 

  41. Hale EK, Pomeranz MK. Dermatological agents during pregnancy and lactation: an update and clinical review. Int J Dermatol. 2002;41:197–203.

    Article  PubMed  Google Scholar 

  42. Cunliffe WJ, C’otterill JA, Williamson B. The effect of clindamycin in acne: a clinical and laboratory investigation. Br J Dermatol. 1972;87:37–41.

    Article  PubMed  CAS  Google Scholar 

  43. Tan SG, Cunliffe WJ. The unwanted effects of clindamycin in acne. Br J Dermatol. 1976;94:313–5.

    Article  PubMed  CAS  Google Scholar 

  44. Owens RC, Donskey CJ, Gayens RP, et al. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis. 2008;46(Suppl. 1):S19–31.

    Article  PubMed  Google Scholar 

  45. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2008.

    Google Scholar 

  46. Romøren M, Lindbæk M, Nordeng H. Pregnancy outcome after gestational exposure to erythromycin: a population-based register study from Norway. Br J Clin Pharmacol. 2012;74:1053–62.

    Article  PubMed  Google Scholar 

  47. Thiboutot D, Gollnick H, Bettoli V, et al. New insights into the management of acne: an update from the Global Alliance to improve outcomes in acne group. J Am Acad Dermatol. 2009;60(5 Suppl.):S1–50.

    Article  PubMed  Google Scholar 

  48. Sweetman SC, et al. Martindale: the complete drug reference. 34th ed. London: Pharmaceutical Press; 2005.

    Google Scholar 

  49. Kus S, Yucelten D, Aytug A. Comparison of efficacy of azithromycin vs. doxycycline in the treatment of acne vulgaris. Clin Exp Dermatol. 2004;30:215–20.

    Article  Google Scholar 

  50. UK Medicines and Healthcare products Regulatory Agency (MHRA) azithromycin UKPAR (UK Public Assessment Reports for medicines). http://www.mhra.gov.uk/home/groups/pl-a/documents/websiteresources/con023376.pdf (Accessed 4 July 2013).

  51. Goodfellow A, Alaghband-Zadeh J, Carter G, et al. Oral spironolactone improves acne vulgaris and reduces sebum excretion. Br J Dermatol. 1984;111:209–14.

    Article  PubMed  CAS  Google Scholar 

  52. Muhlemann MF, Carter GD, Cream JJ, Wise P. Oral spironolactone: an effective treatment for acne vulgaris in women. Br J Dermatol. 1986;115:227–32.

    Article  PubMed  CAS  Google Scholar 

  53. Jaussan V, Lemarchand-Beraud T, Gomez F. Modifications of the gonadal function in the adult rat after fetal exposure to spironolactone. Biol Reprod. 1985;32:1051–61.

    Article  PubMed  CAS  Google Scholar 

  54. Goodfield MJ, Cox NH, Bowser A, et al. Advice on the safe introduction and continued use of isotretinoin in acne in the U.K.: 2010. Br J Dermatol. 2010;162:1172–9.

    Article  PubMed  CAS  Google Scholar 

  55. Lammer EJ, Chen DT, Hoar RM, et al. Retinoic acid embryopathy. N Engl J Med. 1985;313:837–41.

    Article  PubMed  CAS  Google Scholar 

  56. Dreno B, Blouin E. Acne, pregnant women and zinc salts: a literature review. Ann Dermatol Venereol. 2008;135(1):27–33.

    Article  PubMed  CAS  Google Scholar 

  57. Du-Thanh A, Klugr N, Bensalleh H, Guillot B. Drug-induced acneiform eruption. Am J Clin Dermatol. 2011;12:233–45.

    Article  PubMed  Google Scholar 

  58. Seukeran DC, Cunliffe WJ. The treatment of acne fulminans: a review of 25 cases. Br J Dermatol. 1999;141:307–9.

    Article  PubMed  CAS  Google Scholar 

  59. Gur C, Diav-Citrin O, Shechtman S, et al. Pregnancy outcome after first trimester exposure to corticosteroids: a prospective controlled study. Reprod Toxicol. 2004;18:93–101.

    Article  PubMed  CAS  Google Scholar 

  60. Committee on safety of medicines/medicines control agency. Systemic corticosteroids in pregnancy and lactation. Curr Probl. 1998;24:9. http://www.mhra.gov.uk/home/groups/pl-p/documents/websiteresources/con2023392.pdf (Accessed 28 June 2013).

  61. Ross EV. Optical treatments for acne. Dermatol Ther. 2005;18:253–66.

    Article  PubMed  Google Scholar 

  62. Car J, Car M, Hamilton F, et al. Light therapies for acne (intervention protocol). Cochrane Database Syst Rev. 2009;(3):CD007917.

  63. Sakamoto FH, Torezan L, Anderson R. Photodynamic therapy for acne vulgaris: a critical review from basics to clinical practice: part II. Understanding parameters for acne treatment with photodynamic therapy. J Am Acad Dermatol. 2010;63:195–211.

    Article  PubMed  Google Scholar 

  64. Zeichner JA. Narrowband UV-B phototherapy for the treatment of acne vulgaris during pregnancy. Arch Dermatol. 2011;147:537–9.

    Article  PubMed  Google Scholar 

  65. Cunliffe WJ, Holland DB, Clark SM, Stables GI. Comedogenesis: some new aetiological, clinical and therapeutic strategies. Br J Dermatol. 2000;142:1084–91.

    Article  PubMed  CAS  Google Scholar 

  66. Zip C. A practical guide to dermatological drug use in pregnancy. Skin Ther Lett. 2006;11:1–4.

    Google Scholar 

  67. Crider KS, Cleves MA, Reefhuis J, et al. Antibacterial medication use during pregnancy and risk of birth defects. Arch Pediatr Adolesc Med. 2009;163(11):978–85.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Both authors have no relevant conflicts of interest. FMM researched and drafted the initial document, which was then reviewed and edited by ADO.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anthony D. Ormerod.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Meredith, F.M., Ormerod, A.D. The Management of Acne Vulgaris in Pregnancy. Am J Clin Dermatol 14, 351–358 (2013). https://doi.org/10.1007/s40257-013-0041-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-013-0041-9

Keywords

Navigation